BACKGROUND: The effect of the interval between previous Helicobacter pylori (H. pylori) eradication and rescue treatment on therapeutic outcomes remains unknown. The aim of this study was to investigate the association between eradication rates and treatment interval durations in H. pylori infections. METHODS: This prospective observational study was conducted from December 2021 to February 2023 at six tertiary hospitals in Shandong, China. We recruited patients who were positive for H. pylori infection and required rescue treatment. Demographic information, previous times of eradication therapy, last eradication therapy date, and history of antibiotic use data were collected. The patients were divided into four groups based on the rescue treatment interval length: Group A, ≥4 weeks and ≤3 months; Group B, >3 and ≤6 months; Group C, >6 and ≤12 months; and Group D, >12 months. The primary outcome was the eradication rate of H. pylori . Drug compliance and adverse events (AEs) were also assessed. Pearson's χ2 test or Fisher's exact test was used to compare eradication rates between groups. RESULTS: A total of 670 patients were enrolled in this study. The intention-to-treat (ITT) eradication rates were 88.3% (158/179) in Group A, 89.6% (120/134) in Group B, 89.1% (123/138) in Group C, and 87.7% (192/219) in Group D. The per-protocol (PP) eradication rates were 92.9% (156/168) in Group A, 94.5% (120/127) in Group B, 94.5% (121/128) in Group C, and 93.6% (190/203) in Group D. There was no statistically significant difference in the eradication rates between groups in either the ITT ( P = 0.949) or PP analysis ( P = 0.921). No significant differences were observed in the incidence of AEs ( P = 0.934) or drug compliance ( P = 0.849) between groups. CONCLUSION: The interval duration of rescue treatment had no significant effect on H. pylori eradication rates or the incidence of AEs. REGISTRATION ClinicalTrials.gov , NCT05173493.
Humans ; Helicobacter Infections/drug therapy* ; Helicobacter pylori/pathogenicity* ; Male ; Female ; Prospective Studies ; Middle Aged ; Anti-Bacterial Agents/adverse effects* ; Adult ; Aged ; Treatment Outcome ; Proton Pump Inhibitors/therapeutic use*

Objective To explore a method to improve the accuracy and generalization ability of medical diagnostic neural network models under conditions of small data volumes,and to address the issue of poor neural network model performance in computer-aided diagnosis of nail diseases due to limited training data.Methods A dual-model strategy integrating instance segmentation with fine-grained feature classification was proposed.The neural network model based on dual-model strategy was trained using the dataset of Image-Based Intelligent Diagnosis of Nail Disease Model task of the first National Digital Health Innovation Application Competition & Health and Medical Big Data Theme Competition.This dataset covered 8 types of nail diseases,including nail matrix nevi,paronychia,nail psoriasis,onychomycosis,subungual hemorrhage,melanonychia,periungual warts,and nail melanoma,with class imbalance present.The diagnostic performance of the dual-model strategy was evaluated and compared with single-model strategies(image classification models[ResNet50 and Swin Transformer]and target detection model based on faster region-based convolutional neural network[Faster R-CNN])under the same hardware and software training conditions.Results The dataset included 1 048 samples,including 210 cases of nail matrix nevi,186 cases of paronychia,69 cases of nail psoriasis,203 cases of onychomycosis,149 cases of subungual hemorrhage,71 cases of melanonychia,93 cases of periungual warts,and 67 cases of nail melanoma,with 90％used for training various models and 10％for evaluation.The micro F1 score was 0.324 in the image classification model based on ResNet50,0.381 in the image classification model based on Swin Transformer,0.572 in the target detection model based on Faster R-CNN,and 0.714 in the dual-model strategy model Mask R-CNN+Swin Transformer.The accuracy rates for diagnosing different nail diseases in the dual-model strategy were:nail matrix nevi 80.95％(17/21),paronychia 89.47％(17/19),nail psoriasis 100.00％(7/7),onychomycosis 70.00％(14/20),subungual hemorrhage 73.33％(11/15),melanonychia 14.29％(1/7),periungual warts 55.56％(5/9),and nail melanoma 42.86％(3/7).The micro F1 score for evaluating the dual-model strategy on a test set of 1 000 cases was 0.844.Conclusion The dual-model strategy can effectively combine models with different functions to well accomplish the task of intelligent diagnosis of nail diseases under small data volume training conditions.

Objective To investigate the impact of stenting at the origin of vertebral artery (VAO) on cognitive function in patients with first-onset temporal or thalamic infarction. Methods A total of 65 patients with first-onset temporal or thalamic infarction were selected as research subjects, and were diagnosed with new-onset infarction in the medial temporal lobe or thalamus by craniocerebral magnetic resonance imaging (MRI), and severe stenosis of VAO as the responsible vessel for infarction was confirmed by head and neck computed tomography angiography (CTA). A total of 35 patients who received VAO stenting were included in the stenting group, and 30 patients who received drug-based conservative treatment were included in the control group. The Montreal Cognitive Assessment Scale (MoCA), Wechsler Adult Intelligence Scale-Digit Span Test (WAIS-DS), and Fuld Object Memory Evaluation Scale (FOM) scores were compared between the two groups before treatment, 14 days and 3 months after treatment. Results Before treatment, there was no significant difference in the scores of each scale between the two groups (P>0.05). At 14 days and 3 months after treatment, the total MoCA score and the scores of visual space and executive function, delayed recall, and language dimension in the stenting group were higher than those in the control group (P < 0.05). The FOM score in the stenting group was higher than that in the control group at 3 months after treatment (P < 0.05). Conclusion Stenting can significantly improve the cognitive function of patients with temporal lobe and thalamic infarction.

Objective:To search for evidence related to the prevention and management of mechanical complications in patients receiving enteral nutrition and to summarize the evidence.Methods:The evidence published up to March 20, 2022 was systematically retrieved from Cochrane Library, PubMed, American Clinical Guidelines Network, National Institute for Health and Care Excellence, American Society for Parenteral and Enteral Nutrition, CNKI, WanFang Data, SinoMed, etc. The literature evaluation standards and evidence grading system of the Joanna Briggs Institute (JBI) Evidence-Based Health Care Center in Australia were used to rate the quality of the literature, evaluate and summarize the evidence.Result:A total of 13 articles were included, including 4 guidelines, 4 expert consensuses, 4 evidence summaries, and 1 case-control study. Totally 31 best evidences were formed from 8 aspects: causes of occurrence, prevention and management, proper immobilization, regular flushing, reasonable infusion of nutrient solution/medication, treatment of complications-blockage, treatment of complications-mucosal damage, and treatment of complications-unplanned extubation.Conclusions:Medical and nursing staff can use the best evidence to develop and implement prevention and management programs for mechanical complications in patients receiving enteral nutrition, strengthen the scientific management of mechanical complications in these patients, and improve the quality of life and prognosis of patients.

Objective:To review the scope of research on the application of blood flow restriction training in the rehabilitation of patients undergoing anterior cruciate ligament (ACL) reconstruction.Methods:According to the research method of scoping review, computer searches were conducted on China National Knowledge Infrastructure, Wanfang Database, China Biology Medicine disc, VIP, Cochrane Library, PubMed, Embase, with the search period was from eatablishment of databases to December 31, 2022. The included literatures were screened, summarized and analyzed.Results:A total of 16 literatures were included, all of which were randomized controlled trials. The basic content of blood flow restriction training intervention included 8 aspects, such as intervention time, training intensity, training amount, training mode, frequency, interval time, training cycle and blood flow restriction pressure. The effect evaluation mainly involved two kinds of indexes, namely safety indicators and efficacy indicators.Conclusions:Blood flow restriction training can effectively enhance muscle strength and improve knee joint function in patients undergoing ACL reconstruction. Future studies should focus on exploring the best intervention strategy, formulating standardized and unified evaluation criteria and providing the best blood flow restriction training program for patients undergoing ACL reconstruction.

Objective To systematically evaluate the effect of early mobilization on the physical function of patients in intensive care unit (ICU). Methods The randomized controlled trials (RCT) about early intervention in ICU patients were retrieved from the Cochrane Library, PubMed, Wed of Science, Medline, CBM, CNKI, VIP, and Wanfang database, all of which were published literatures from the establishment to October 2018. Early activities were carried out in the intervention group, while only routine nursing was carried out in the control group. Outcome measures included the medical research council score (MRC-Score), physical function ICU test (PFIT), independent walking ability, score of quality of life health survey short form (SF-36), incidence of ICU-acquired weakness (ICU-AW) and hospital mortality. Two researchers independently screened the literature, evaluated the quality of the literature and extracted the data. After literature selection, literature quality evaluation and date extraction was performed, and RevMan 5.3 software was used for Meta-analysis. The publication bias was analyzed by funnel plot. Results A total of 13 literatures were included, 10 in English and 3 in Chinese; of the 1 347 patients, 695 in intervention group and 652 in control group. Compared with the control group, the MRC-Score was increased in intervention group [mean difference (MD) = 4.74, 95% confidence interval (95%CI) = 2.30-7.19, P = 0.000 1], independent walking ability was improved [odds ratio (OR) = 2.04, 95%CI =1.39-2.99, P = 0.000 3], the incidence of ICU-AW was decreased (OR = 0.22, 95%CI = 0.14-0.35, P < 0.000 01), and there was no significant difference in PFIT (MD = -0.19, 95%CI = -0.69-0.31, P = 0.46), physical health (PCS) after 6 months (MD = -1.39, 95%CI = -4.18-1.39, P = 0.33) and inpatient mortality (OR = 0.77, 95%CI = 0.53-1.12, P = 0.17) between two groups. It was shown by funnel plot that the publication bias of each literature was relatively small in terms of MRC-Score, PFIT, independent walking ability and SF-36. Conclusion Early mobilization are beneficial for the physical function recovery of ICU patients, which can improve the muscle strength, improve the ability of patients to walk independently, reduce the occurrence of ICU-AW, and do not increase the mortality rate in hospital.

OBJECTIVE: To analyze the current status of diagnosis and management of acute appendicitis (AA) in China. METHODS: Questionnaire survey was used to retrospectively collect data of hospitalized patients with AA from 43 medical centers nationwide in 2017 (Sort by number of cases provided: Jinling Hospital of Medical School of Nanjing University, The First Affiliated Hospital of Xinjiang Medical University, Lu'an People's Hospital, Tengzhou Central People's Hospital, Dalian Central Hospital, The Affiliated Hospital of Xuzhou Medical University, Dongying People's Hospital, Jinjiang Hospital of Traditional Chinese Medicine, Huangshan Shoukang Hospital, Xuyi People's Hospital, Nanjing Jiangbei People's Hospital, Lanzhou 940th Hospital of PLA, Heze Municipal Hospital, The First College of Clinical Medical Science of China Three Gorges University, Affiliated Jiujiang Hospital of Nanchang University, The Second People's Hospital of Hefei, Affiliated Central Hospital of Shandong Zaozhuang Mining Group, The Third People's Hospital of Kunshan City, Xuzhou First People's Hospital, The 81st Group Army Hospital of PLA, Linyi Central Hospital, The General Hospital of Huainan Eastern Hospital Group, The 908th Hospital of PLA, Liyang People's Hospital, The 901th Hospital of Joint Logistic Support Force, The Third Affiliated Hospital of Chongqing Medical University, The Fourth Hospital of Jilin University, Harbin Acheng District People's Hospital, The First Affiliated Hospital of Zhengzhou University, Nanjing Luhe People's Hospital, Taixing Municipal People's Hospital, Baotou Central Hospital, The Affiliated Hospital of Nantong University, Linyi People's Hospital, The 72st Group Army Hospital of PLA, Zaozhuang Municipal Hospital, People's Hospital of Dayu County, Taixing City Hospital of Traditional Chinese Medicine, Suzhou Municipal Hospital, Beijing Guang'anmen Hospital, Langxi County Hospital of Traditional Chinese Medicine, Nanyang Central Hospital, The Affiliated People's Hospital of Inner Mongolia Medical University).The diagnosis and management of AA were analyzed through unified summary. Different centers collected and summarized their data in 2017 and sent back the questionnaires for summary. RESULTS: A total of 8 766 AA patients were enrolled from 43 medical centers, including 4 711 males (53.7%) with median age of 39 years and 958 (10.9%) patients over 65 years old. Of 8 776 patients, 5 677 cases (64.6%) received one or more imaging examinations, and the other 3 099 (35.4%) did not receive any imaging examination. A total of 1 858 (21.2%) cases received medical treatment, mainly a combination of nitroimidazoles (1 107 cases, 59.8%) doublet regimen, followed by a single-agent regimen of non-nitroimidazoles (451 cases, 24.4%), a nitroimidazole-free doublet regimen (134 cases, 7.2%), a triple regimen of combined nitroimidazoles (116 cases, 6.3%), nitroimidazole alone (39 cases, 2.1%) and nitroimidazole-free triple regimen (3 cases, 0.2%). Of the 6 908 patients (78.8%) who underwent surgery, 4 319 (62.5%) underwent laparoscopic appendectomy and 2589 (37.5%) underwent open surgery. Ratio of laparotomy was higher in those patients under 16 years old (392 cases) or over 65 years old (258 cases) [15.1%(392/2 589) and 10.0%(258/2 589), respectively, compared with 8.5%(367/4 316) and 8.0%(347/4 316) in the same age group for laparoscopic surgery, χ²=91.415, P<0.001; χ²=15.915,P<0.001]. Patients with complicated appendicitis had higher ratio of undergoing open surgery as compared to those undergoing laparoscopic surgery [26.7%(692/2 589) vs. 15.6%(672/4 316), χ²=125.726, P<0.001].The cure rates of laparoscopic and open surgery were 100.0% and 99.8%(2 585/2 589) respectively without significant difference (P=0.206). Postoperative complication rates were 4.5%(121/2 589) and 4.7%(196/4 316) respectively, and the difference was not statistically significant (χ²=0.065, P=0.799). The incidence of surgical site infection was lower (0.6% vs. 1.7%, χ²=17.315, P<0.001), and hospital stay was shorter [6(4-7) days vs. 6(5-8) days, U=4 384 348.0, P<0.001] in the laparoscopic surgery group, while hospitalization cost was higher (median 12 527 yuan vs. 9 342 yuan, U=2 586 809.0, P<0.001). CONCLUSIONS The diagnosis of acute appendicitis is still clinically based, supplemented by imaging examination. Appendectomy is still the most effective treatment at present. Laparoscopic appendectomy has become the main treatment strategy, but anti-infective drugs are also very effective.
Acute Disease ; Adolescent ; Adult ; Aged ; Anti-Bacterial Agents ; therapeutic use ; Appendectomy ; Appendicitis ; diagnosis ; therapy ; China ; Female ; Health Care Surveys ; Humans ; Laparoscopy ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome ; Young Adult

OBJECTIVETo analyze the relation of HBV infection with clinical characteristics and prognosis in NHL patients, so as to explore the significance of HBV detection.

METHODSSixty-eight NHL patients from December 2013 to December 2016 were enrolled in NHL group and 136 patients with other malignancies were chosen in control group, the detectable rate of HBV was compared between 2 groups. The correlation of HBV infection with sex, age, stage, cell origin, expression of P53 and BCL-2 in NHL patients was analyzed. The prognosis-related factors in NHL patients were also analyzed.

RESULTSThe infection rate of HBV in NHL group was 51.47%(35/68), that in control group was 15.44% (21/136), and the difference was statistically significant(χ=27.768,P<0.05). HBV infection correlated with cell origins and expression of BCL-2 in NHL patients(P<0.05). The prognosis of NHL patients demonstrated no correlation with sex, age, cell origins and HBV infection (P>0.05), while the prognosis was significantly related with stage, expression of P53 and BCL-2(P<0.05).

CONCLUSIONHBV infection correlates with BCL-2 expression level of NHL patients, and shows influence on the prognosis of patients.

Objective This study aimed to investigate the role of pyrroloquinoline quinone (PQQ) in repairing oxidative nerve cells,and to study the antioxidant capacity of PQQ on the oxidative damage of rats caused by apolexis,as well as the effects on learning and memory abilities of apolexis rats.Methods Oxidative damage of PC12 was induced by H2O2,and the repairing rate of PQQ on oxidative PC12 cells was tested by methylthiazolyldiphenyl-tetrazolium bromide assay kit.The 18-month-old male SD rats were administered PQQ (0,10,20,40 mg/kg).After 4 weeks,Morris water maze test was used to test the learning and memory ability.After 6 weeks,serum and brain tissue related indicators and antioxidant capacity were recorded.Results The survival rate of PC12 cells increased from 59.1％ to 90.5％ with 200 nmol/L PQQ.Compared with the apolexis model group,the latency of the PQQ group (20,40 mg/kg) was shortened in the Morris water maze experiment,the swimming distance was reduced,pass-through counts were increased,and the first secure platform pass-through was reduced.Meanwhile,the levels of malondialdehyde and lipofuscin in serum and brain tissue of PQQ group decreased,the levels of superoxide dismutase,glutathione peroxidase vitality,antioxidant capacity of PQQ group (20,40 mg/kg) were enhanced.Conclusion PQQ could repair the oxidative damage of nerve cells,and it was confirmed that PQQ could play the same antioxidant effect in body and brain,and increase the learning and memory ability of apolexis rats.

Objective To explore the relationship between acid pocket and acid reflux in gastroesophageal reflux disease (GERD).Methods From March 2011 to January 2012,29 patients with GERD were enrolled and nine healthy individuals were set as control.All objects of this study accepted esophageal manometry test,acid pocket test,test of the occurrence time of acid pocket and ambulatory 24 hours pH monitoring.The t-test was performed for comparison between two groups.The relationship between the incidence of GERD and acid pocket was analyzed by Logistic regression analysis.Pearson correlation analysis was used for correlation analysis.Results The percentage of acid pocket in GERD group and control group was 58.6％ (17/29) and 5/9,respectively,and the difference was not statistically significantly (P＞0.05).The duration time of acid pocket was (56.3±44.7) minutes in GERD group which was longer than that of control group ((16.0±8.2) minutes) and the difference was statistically significant (t=1.970,P＜0.01).There was no statistical significance in the average pH value of acid pocket between GERD group with acid pocket (2.8 ± 1.3) and that of control group with acid pocket (1.9±0.5,P＞0.05).The duration time of acid pocket was correlated with the longest reflux time in GERD group with acid pocket (r=0.550,P＜0.01).The peak velocity of esophageal motility in GERD group ((3.3±0.6) cm/s) was lower than that of control group ((5.0±4.1) cm/s) and the difference was statistically significant (t=-1.354,P＜0.05).The peak velocity of esophageal motility in GERD group with acid pocket ((3.2±0.6) cm/s) was lower than that of control group with acid pocket ((7.2± 6.3) cm/s) and the difference was statistically significant (t=-2.693,P＜0.05).Conclusions The duration time of acid pocket in GERD is correlated with the time of acid reflux.Esophageal dysmotility may be related with the pathogenesis of GERD and the occurrence of acid pocket.